摘要
目的评价卡泊芬净联合万古霉素治疗肾移植术后肺部感染患者的疗效。方法选取西安交通大学第一附属医院2018年8月—2019年10月收治的肾移植术后肺部感染患者122例为研究对象,按照随机数表法将患者分为对照组和观察组,每组各61例。对照组患者静脉滴注注射用盐酸去甲万古霉素,250 mg/次,采用0.9%氯化钠注射液250 mL溶解,滴注时间>1 h,12 h/次。用药3 d后,根据血药浓度谷峰值调整给药剂量。观察组患者在对照组的基础上静脉滴注注射用醋酸卡泊芬净,首次给药剂量为70 mg,使用200 mL葡萄糖溶液溶解,第2天开始以维持剂量为50 mg治疗,1次/d。两组疗程均为14 d。观察两组患者的临床疗效,比较两组治疗前后的肾功能指标、肺功能指标及血气指标水平。结果治疗后,观察组治疗后总有效率为91.80%,显著高于对照组的77.05%,两组总有效率比较差异具有统计学意义(P<0.05);治疗后,观察组细菌完全清除率为34.43%,显著高于对照组的14.75%,两组细菌完全清除率比较差异有统计学意义(P<0.05)。两组患者治疗后尿微量白蛋白/肌酐比值(ACR)、血肌酐(Scr)、尿β2-微球蛋白均显著升高(P<0.05),组间比较观差异无统计学意义。两组患者治疗后肺功能指标第1秒用力呼气容积用力呼气容积(FEV1)、第1秒用力呼气容积占预计值百分比(FEV1%pred)和FEV1/FVC均显著升高(P<0.05),治疗后,观察组肺功能指标水平显著高于对照组,差异具有统计学意义(P<0.05)。治疗后,两组患者的动脉血氧饱和度(SaO_(2))、动脉血氧分压(pO_(2))和氧合指数(OI)均显著升高,动脉血二氧化碳分压(pCO_(2))显著降低,同组治疗前后比较差异具有统计学意义(P<0.05);治疗后,观察组患者的SaO_(2)、pO_(2)、OI显著高于对照组,pCO2明显低于对照组(P<0.05)。结论卡泊芬净联合万古霉素治疗肾移植术后肺部感染具有可靠的应用价值,能够有效抑制患者肺部感�
Objective To evaluate the efficacy of caspofungin combined with vancomycin in treatment of pulmonary infection after renal transplantation.Methods A total of 122 patients with pulmonary infection after renal transplantation admitted to the First Affiliated Hospital of Xi’an Jiaotong University from August 2018 to October 2019 were selected as study subjects.According to the random number table method,the patients were divided into control group and observation group,with 61 patients in each group.Patients in the control group were iv administered with Norvancomycin Hydrochloride for Injection,250 mg/time,dissolved in 0.9%sodium chloride injection 250 mL,and the infusion time was less than 1 h,12 h/time.After 3 days,the dose was adjusted according to the peak value of blood concentration.Patients in the observation group were iv administered with Caspofungin Acetate for Injection on the basis of the control group,the first dose was 70 mg,and 200 mL glucose solution was used for dissolution.The maintenance dose was 50 mg at the beginning of the second day,once daily.The course of treatment in both groups was 14 days.The clinical efficacy of two groups was observed,and the renal function index,lung function index,and blood gas index level before and after treatment were compared.Results After treatment,the total effective rate of the observation group was 91.80%,which was significantly higher than 77.05%of the control group,and the difference between two groups was statistically significant(P<0.05).After treatment,the bacterial clearance rate of the observation group was 34.43%,which was significantly higher than 14.75%of the control group,and the difference between two groups was statistically significant(P<0.05).After treatment,ACR,Scr and urineβ2-microglobulin were significantly increased in two groups(P<0.05),and there was no statistically significant difference between two groups.After treatment,lung function indexes of FEV1,FEV1%pred,and FEV1/FVC were significantly increased in two groups(P<0.05).After trea
作者
赵王成
景桂霞
李亚娟
高赛
王乐
史可薇
高媛
高巍
ZHAO Wangcheng;JING Guixia;LI Yajuan;GAO Sai;WANG Le;SHI Kewei;GAO Yuan;GAO Wei(Department of Anesthesia and Surgery,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;Department of Anesthesiology,3201 Hospital,Hanzhong 723000,China)
出处
《药物评价研究》
CAS
2020年第12期2463-2468,共6页
Drug Evaluation Research
基金
国家自然科学基金资助项目(81771485,81971290)
陕西省创新人才推进计划—青年科技新星项目(2019KJXX-046)
陕西省重点研发计划项目(2020SF-136)
西安交通大学第一附属医院临床研究中心面上项目(XJTU1AF-CRF-2017-012)
校级中央高校基本科研业务费(xjj2018262)。
关键词
卡泊芬净
万古霉素
肾移植术
肺部感染
肾功能
肺功能
血气指标
caspofungin
vancomycin
renal transplantation
pulmonary infection
renal function
lung function
blood gas index
